If the vaccine works so well, why is COVID-19 surging again in Pennsylvania?

The numbers might seem to give plenty of ammo to COVID-19 vaccine doubters.

As the share of vaccinated people in Pennsylvania has grown over the summer and fall, so has the number of COVID-19 cases. As of Thanksgiving week, the daily case count and number hospitalized was similar to a year earlier, when no one was vaccinated. The trajectory seemed similar to the one that severely stressed hospitals and culminated in more than 200 deaths per day shortly after Christmas last year.

Doctors, however, continue to predict it won’t get that bad again.

They further say the data, particularly hospitalizations and deaths, provide plenty of evidence the vaccine is getting the job done.

“I would say this vaccine does exactly what it’s supposed to do. It decreases the number of cases by sixfold. It decreases your chances of dying or ending up in the hospital by tenfold,” said Dr. John Goldman, a UPMC infectious disease specialist.

He’s referring to assessments such as a recent report from the U.S. Centers for Disease Control and Prevention which said unvaccinated people were 5.8 times more likely to test positive for COVID-19 and 14 times more likely to die of it.

Further, Goldman says vaccine has altered the character of the disease from one that preyed almost exclusively on the elderly, to one that is now having its worst effects on younger, unvaccinated people.

He says the proof is on display in UPMC hospitals and intensive care units.

“We’re no longer seeing mainly older people. The average severely ill patient is a 40-to-64-year-old, unvaccinated,” Goldman said. “We actually don’t see a lot of 65 and above, because 65 and aboves are vaccinated. In fact, a 50- to 64-year old who is unvaccinated is more likely to die than an 80-plus-year-old who is vaccinated.”

Other central Pennsylvania doctors described similar scenarios.

As of Nov. 26, Penn State Health was caring for 130 adult and five pediatric COVID-19 patients at its four hospitals. Of those whose vaccination status was known, 86 were less than fully vaccinated compared to 29 who were fully vaccinated. Moreover, 24 of the patients not fully vaccinated were in intensive care and 11 were on ventilators. That compared to eight fully vaccinated patients in intensive care and four on ventilators.

“People who are getting breakthrough infections are not as sick as people who are unvaccinated,” said Dr. Mohammed Ali, the lead infectious disease physician at Penn State Health’s Holy Sprit and Hampden medical centers. “I have so many younger individuals who are very sick and who end up on oxygen for prolonged periods of time and some of them don’t make it … Most of the vaccinated people have only a mild illness.”

WellSpan Health was caring for 223 COVID-19 patients as of last week, said Dr. Mark Goedecker, a WellSpan family medicine specialist. Eighty-seven percent were unvaccinated, as were 89% of the ones in intensive care, and 92% of the ones on ventilators, he said.

Goedecker was asked whether Pennsylvania’s surging level of new cases and hospitalizations undermines the argument for vaccination.

He stressed that while the vaccines are less than 100% effective, “they’re very good at preventing severe disease, hospitalization and death.”

“We are not going to prevent COVID in every single person by giving them a vaccine, but you will definitely get that extra layer of protection to prevent you from getting hospitalized, from dying from this,” he said.

Still, with so many Pennsylvanians vaccinated, how can we have such a surge in cases?

Central Pennsylvania doctors attribute it mostly to the emergence of the more contagious delta variant, considered several times more contagious than strains that were prevalent prior to summer. They also point to fewer restrictions than during the first year or so of the pandemic, more people back at the office and school, and people letting their guards down regarding preventive steps such as wearing face masks.

Also, colder weather is keeping Pennsylvanians indoors where COVID-19 spreads easier. The same is happening in other northern states, which are now seeing surges similar to the ones seen in southern states over the summer, when hot weather kept people indoors, Ali said.

Moreover, even Pennsylvania, in the upper half of states in terms of its vaccination rate, still has many unvaccinated people.

In fact, Pennsylvania’s vaccination picture abruptly turned out to be something of a mirage last week.

The CDC, after sorting out data problems such as double counts, last week said the number of fully vaccinated adult Pennsylvanians is only 68.8% — significantly less than the previous figure of 73.7%. A Pennsylvania Department of Health spokeswoman said it amounts to nearly 1.1 million people who were believed to be fully vaccinated who, as it turns out, are not.

Even before the revision, when it seemed only about a quarter of Pennsylvania adults were less than fully vaccinated, Goedecker said: “You look at Pennsylvania which has 13 million people. That’s still a lot of (unvaccinated) people. And so I think there’s still potential for this disease to spread and for hospitalizations to go up if we’re not careful.”

Still, the doctors predict the present surge will end before it repeats the level of last winter’s surge, especially in terms of COVID-19 deaths.

On Sunday, Pennsylvania’s seven-day average of new infections stood at 5,344, according to tracking by Johns Hopkins University. Its average daily death count was 46.

A year earlier, Pennsylvania was averaging 6,674 new infections and 84 deaths.

Pennsylvania’s peak daily average of new infections, 10,631, came last Dec. 13, according to Johns Hopkins data. Its daily average number of deaths peaked at 222 on Jan. 12.

As of Monday, Pennsylvania’s 14-day average of hospitalized COVID-19 patients stood at 3,278, similar to Nov. 29, 2020, according to state health department data. Pennsylvania’s daily average for hospitalizations peaked at about 6,100 around Christmas.

Before we reach those levels again, doctors predict, a combination of vaccinated people and unvaccinated people who have been infected, and therefore have some immunity, will bring us to a point where there aren’t many people left to get infected.

While it’s impossible to know how many, doctors say the latest case numbers suggest Pennsylvania still has a substantial number of people who are unvaccinated and who lack immunity gained from natural infection.

“I don’t know how close we are, but I think we are getting, hopefully, to the point that we will not see the large number of hospitalizations that we are seeing now,” Goedecker said. “I think if we can get more people vaccinated, it’s going to really slow it down or cause it to decline.”

Penn State Health’s Ali said: “I don’t envision this is going to be like last winter … Perhaps this winter is the last stand.”

Yet even as they spoke, the world was just learning of a new variant, called omicron, which is fueling a new surge in South Africa. It’s considered a certainty omicron will spread throughout the world. Doctors, still in the early stages of understanding it, said omicron seems more contagious than delta, but there are no immediate signs it’s making people sicker, or that it can evade vaccine.